Individual
MS. HAZEL A. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5674
(912) 435-6367
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5674
(912) 435-6367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10096
SC
1041C0700X
Clinical Social Worker
C006810
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
05/26/2010
Last updated
06/13/2016
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